Oshawa woman fights for annual Pap tests

Oshawa resident Jessica Grigg has cervical and ovarian cancer. She has started a petition, which has more than 500 signatures, urging the province to change the current guideline of a Pap test every three years to an annual test.

By Lindsey Cole/The Oshawa Express

Jessica Grigg made the conscious choice to have a Pap test every six months.

This decision likely saved her life.

Grappling with pain and discomfort from a very young age, Grigg was just 13when she lost one of her ovaries to a cyst. Year after year, from the age of 16, she got screened, as the pain continued. She was later diagnosed with endometriosis, which is when cells from the lining of the uterus appear outside the uterine cavity.

Because of this, Grigg wanted to make sure she was healthy, so she chose to be screened every six months for cervical cancer.

“I was going every six months and never had abnormal results,” says the 24-year-old Oshawa resident.

Her last normal test was in January 2011. When she went back again in July, at age 22, she was diagnosed with cervical cancer.

“I had no signs or symptoms or reason to believe something was wrong,” she states. “It was not a result of HPV (the human Papillomavirus, which can cause cervical cancer). It was very early. It wasn’t just cancer cells though, it was cancer.”

If that news wasn’t bad enough, soon after, during her fight against cervical cancer, ovarian cancer was detected.

“I still wouldn’t know right now,” she says. “If I had waited three years for my next PAP test due to OHIP funding, I would still not know of my cervical or even ovarian cancer today. I would not have even begun my fight against cancer yet. I would have been deprived of the last year-and-a half I have been given to fight. Who knows what stage my cancer would be in today or where it would have spread.”

This is the crux of her argument. Grigg has created an online petition, which now has more than 500 signatures, pleading with the provincial government to reconsider a recent move to only cover Pap tests once every three years.

As was common practice for some physicians, the Ontario Health Insurance Plan (OHIP) previously covered a Pap test once a year. This included cervical cancer screening. However, as of January 1 OHIP will now only cover the test once every three years – unless abnormal results appear. The Ontario Ministry of Health (MOH) will be saving $1.5 million in 2012/13 and $6.1 million in 2013/14 as a result of this change.

“Now it will go out of your pocket, which is horrible,” if you want to go once a year, Grigg says. “I look at the amount of deaths there were (from cervical cancer last year, which she cites from the Canadian Cancer Society as 390). How many more deaths will there be, just to save money? I find it so surprising that no one knew of it. Young women will think they don’t really want to spend the money.”

The test could cost around $20, but that also depends on the physician fee.

Oshawa Councillor Amy England, who has been an advocate for women to get testing in general, says if a woman wants to be tested every year because she has concerns she shouldn’t be charged.

“If a woman wants or chooses to abide by the guidelines, then that’s her choice. But if she wants, for her own health, to be checked once a year, she should be able to do so.”

She says ovarian cancer is often a “silent killer” and can go undetected.

“Sometimes doing that Pap test…sometimes that can save a life.”

But while Grigg is adamant more women need to know about this and need frequent testing, both the Ontario MOH and Cancer Care Ontario state more tests can cause more harm than good.

“We’re very pleased that there is so much interest in this,” says Dr. Joan Murphy, clinical lead with Cancer Care Ontario, adding there are some misconceptions being put out there. “We’ve never formally recommended annual tests. This change is not as big of change as it would seem.”

Dr. Murphy says PAP tests can be invasive, cause anxiety and discomfort. It is recommended that women 21 and over get a PAP test every three years.

“It is now understood that too frequent Pap smears leads to over diagnosis and exposure to repeat testing/more invasive testing that is unnecessary and may be harmful,” adds the MOH in a statement. “If a screening Pap smear is found to be abnormal or if a woman’s immune system is compromised, Pap smears remain insured for any age woman without specific limits. Most abnormalities correct themselves but for those that do worsen, all diagnostic tests for the abnormality remain insured services.”

Dr. Murphy reiterates that “the Pap test in and of itself is a flag, it’s not a diagnostic test. The Pap can’t distinguish…between an innocent change and a significant one. They (women) sometimes underestimate the potential for harm. We’re trying to limit the likelihood of harm.”

“The MOH and OHIP chose their fee schedule so the physician will only get paid once every three years. Women think it is such a dramatic change. Cancer Care Ontario has never recommended annually.”

The MOH states the reason they are following Cancer Care Ontario’s clinical guidelines is because it is “based on the best available, high quality evidence. The intention of these guidelines is to support and assist health care providers in exercising their clinical discretion and decision making.”

Cancer Care Ontario is an agency of the Ontario government and its mandate is “to drive continuous quality improvement in disease prevention and screening as well as delivery of care for cancer, chronic kidney disease and improved access to care for key health services,” states the MOH.

Dr. Murphy says in order to remind women that cervical cancer screening should be done every three years there will be reminders sent out and invitations as well for those who are 21.

“Women in Ontario will be protected. I can tell you with certainty the economics of it all…was not the purpose of the process. Not our goal,” she adds in reference to this change being strictly for the government to save money.

“The introduction of new cervical screening guidelines is not a cost savings exercise,” reiterates the MOH. “Any savings resulting from this change are relatively small. Evidence shows that too frequent screening has resulted in many false positive findings, which require follow up services that create anxiety as well as more invasive procedures that harm women.”

“Our job is to reduce the burden of cancer in the population,” adds Dr. Murphy. She says if this decision were to cause more harm, “that would be a failure for us.”

But Grigg sees it all differently, and so too do the number of people signing her petition. She sees her story as one that should be duly noted and learned from.

Currently, she is going through hormone treatment for her cancer, which she says is stable. The doctors are doing everything they can to prevent her from having a hysterectomy.

“Because I only have one ovary they are trying to do what they can,” she explains, adding she was lucky it was caught so early. “It could have done so much damage. Because I’ve been dealing with this at a young age…every doctor I’ve worked with has been amazing. The doctors told me not to give up. It’s made me a stronger person.”

She says having a hysterectomy would be like “I’m giving up the fight. I will, the day they tell me I can’t (fight) anymore.”

Grigg says while fighting cancer has been tough, this current campaign has sparked a fire in her, that she hopes in some way will evoke change.

“I was just so angry and frustrated. Even if this petition doesn’t change anything, this has brought awareness,” she says. “It’s not going to be a failure. I just really want women to see how important this is. I don’t want the government to wait three years and then see the results. Then it is too late.”

To sign the petition, go to www.change.org and search for Jessica Grigg.